1) Workforce projections for physician shortages and surpluses have often been inaccurate in the past.
2) Current projections of shortages could impact future medical professionals.
3) Several factors will influence the future of allopathic medicine, including lack of universal healthcare coverage, costs, demographics, regulatory burdens, and new technologies.
Neuroethics: Two traditions at the intersection of mind, meaning, and moralityThe Hastings Center
The Hastings Center
The World of Bioethics Seminar
Friday, December 4, 2009
Neuroethics: Two traditions at the intersection of mind, meaning and morality
Presented by: James Giordano
Since 2002, neuroethics has come to include two sorts of research: the first relating to the neurological basis of moral knowledge, sense and actions, and the second referring to the ethics of neuroscientific research and applications. This lecture will address both of these traditions and their relation to one another. It will ground neuroethics in the hard questions of neuroscience, and the problems that arise when we must rely on partial or contingent knowledge.
This document discusses the emerging field of neuroethics and some of the ethical issues raised by new neurotechnologies. It explores how brain imaging can provide insights into human thought and behavior but also raises concerns about privacy, discrimination, and the interpretation of brain data. The use of neuroimaging in legal cases and its ability to predict behavior are examined, as well as the challenges of handling incidental findings in research. Clear guidelines are needed regarding how neuroscience data can be collected and applied in ethical ways that benefit rather than harm individuals and society.
This webinar is part of a 2-hour monthly series hosted by the Neurotechnology Innovation Network: https://ktn-uk.org/health/neurotechnology/
Each webinar features expert speakers and focusses on a new development in a different technology area.
The third topic in this series is Dementia treatment using a biodesign approach. Dementia can have enormous effects, not only to those suffering but also family members and others
caring for them, but there are currently no effective therapies available. Neurotechnology offers a new way of treating dementia.
There is growing evidence that technologies such as deep brain stimulation and transcranial magnetic stimulation could help treat some of the effects of dementia and brain-computer interfaces are now able to detect the first signs of dementia years before symptoms appear.
In collaboration with UK Dementia Research Institute this webinar explores novel neurotechnologies to treat dementia, discuss barriers to adoption and new opportunities in the field.
This document introduces neuroethics and outlines some of its key topics and issues. It discusses the goals of integrating course materials and suggesting ways to further involve oneself in neuroethics. Some areas covered include classical bioethics concerns, emerging technologies that monitor and manipulate the brain/mind, and debates around personhood, enhancement and privacy. Cross-cutting issues like safety, autonomy and premature adoption are also noted. Students are encouraged to continue learning through relevant publications, websites and future neuroethics society meetings.
The document summarizes a non-profit research foundation that aims to translate advanced science into personalized health programs. It formed 2.5 years ago in San Diego. It discusses using new science like genomics, predictive biomarkers, and health tracking devices to create an integrated optimal health program. This program would include comprehensive biomarker testing, personalized recommendations, and health coaching. It then outlines a demonstration project to test this program on 100 volunteers over 3 weeks, collecting genetic, medical, and autonomic data to develop personalized plans.
The rise of the 'ePatient': how it is affecting clinical practice and research
The document discusses how engaged patients, or "ePatients", who actively gather their own health data and conduct their own research are affecting clinical practice and research. It describes how ePatients are empowered through personal health records, diagnostic testing, genomic data, and self-monitoring devices. This shift towards participatory health challenges traditional clinician-led models and will require changes in areas like privacy, education, and how data is integrated into care.
This document discusses using virtual physiological modeling and simulation to enable personalized medicine approaches. It describes the Virtual Physiological Human initiative, which aims to enable collaborative investigation of the human body across all relevant scales through multiscale modeling. As a case study, it discusses using VPH simulation to model HIV protease drug binding at an atomic level to predict patient-specific drug efficacy and rank available drugs for treatment. Automating such simulations through high-performance computing resources could help clinicians interpret genetic information and select optimal drug therapies on an individual basis.
The document discusses the challenges facing academic health centers including rising healthcare costs, uncertain research funding, reimbursement declines, an aging population, and physician shortages. It notes opportunities in areas of unmet need, aging demographics, technology advances in areas like genomics and predictive health. Successfully integrating missions of clinical care, research, and education will be important for academic health centers moving forward.
Neuroethics: Two traditions at the intersection of mind, meaning, and moralityThe Hastings Center
The Hastings Center
The World of Bioethics Seminar
Friday, December 4, 2009
Neuroethics: Two traditions at the intersection of mind, meaning and morality
Presented by: James Giordano
Since 2002, neuroethics has come to include two sorts of research: the first relating to the neurological basis of moral knowledge, sense and actions, and the second referring to the ethics of neuroscientific research and applications. This lecture will address both of these traditions and their relation to one another. It will ground neuroethics in the hard questions of neuroscience, and the problems that arise when we must rely on partial or contingent knowledge.
This document discusses the emerging field of neuroethics and some of the ethical issues raised by new neurotechnologies. It explores how brain imaging can provide insights into human thought and behavior but also raises concerns about privacy, discrimination, and the interpretation of brain data. The use of neuroimaging in legal cases and its ability to predict behavior are examined, as well as the challenges of handling incidental findings in research. Clear guidelines are needed regarding how neuroscience data can be collected and applied in ethical ways that benefit rather than harm individuals and society.
This webinar is part of a 2-hour monthly series hosted by the Neurotechnology Innovation Network: https://ktn-uk.org/health/neurotechnology/
Each webinar features expert speakers and focusses on a new development in a different technology area.
The third topic in this series is Dementia treatment using a biodesign approach. Dementia can have enormous effects, not only to those suffering but also family members and others
caring for them, but there are currently no effective therapies available. Neurotechnology offers a new way of treating dementia.
There is growing evidence that technologies such as deep brain stimulation and transcranial magnetic stimulation could help treat some of the effects of dementia and brain-computer interfaces are now able to detect the first signs of dementia years before symptoms appear.
In collaboration with UK Dementia Research Institute this webinar explores novel neurotechnologies to treat dementia, discuss barriers to adoption and new opportunities in the field.
This document introduces neuroethics and outlines some of its key topics and issues. It discusses the goals of integrating course materials and suggesting ways to further involve oneself in neuroethics. Some areas covered include classical bioethics concerns, emerging technologies that monitor and manipulate the brain/mind, and debates around personhood, enhancement and privacy. Cross-cutting issues like safety, autonomy and premature adoption are also noted. Students are encouraged to continue learning through relevant publications, websites and future neuroethics society meetings.
The document summarizes a non-profit research foundation that aims to translate advanced science into personalized health programs. It formed 2.5 years ago in San Diego. It discusses using new science like genomics, predictive biomarkers, and health tracking devices to create an integrated optimal health program. This program would include comprehensive biomarker testing, personalized recommendations, and health coaching. It then outlines a demonstration project to test this program on 100 volunteers over 3 weeks, collecting genetic, medical, and autonomic data to develop personalized plans.
The rise of the 'ePatient': how it is affecting clinical practice and research
The document discusses how engaged patients, or "ePatients", who actively gather their own health data and conduct their own research are affecting clinical practice and research. It describes how ePatients are empowered through personal health records, diagnostic testing, genomic data, and self-monitoring devices. This shift towards participatory health challenges traditional clinician-led models and will require changes in areas like privacy, education, and how data is integrated into care.
This document discusses using virtual physiological modeling and simulation to enable personalized medicine approaches. It describes the Virtual Physiological Human initiative, which aims to enable collaborative investigation of the human body across all relevant scales through multiscale modeling. As a case study, it discusses using VPH simulation to model HIV protease drug binding at an atomic level to predict patient-specific drug efficacy and rank available drugs for treatment. Automating such simulations through high-performance computing resources could help clinicians interpret genetic information and select optimal drug therapies on an individual basis.
The document discusses the challenges facing academic health centers including rising healthcare costs, uncertain research funding, reimbursement declines, an aging population, and physician shortages. It notes opportunities in areas of unmet need, aging demographics, technology advances in areas like genomics and predictive health. Successfully integrating missions of clinical care, research, and education will be important for academic health centers moving forward.
eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Theera-Ampornpunt N. The intersection of ICT and health informatics research. Presented at: Faculty of ICT, Mahidol University; 2012 Feb 24; Bangkok, Thailand.
Research Frontier: Cognitive Performance GenomicsMelanie Swan
Research Frontier: Cognitive Performance Genomics
New category in personal genomics research
Working with the brain: virtually all cognitive performance and mental health issues are a question of awareness of state or behavior
This document discusses how broadband technologies can enable personalized and participatory medicine. It describes how broadband can help improve youth mental health services and aged care through remote monitoring, telehealth, and electronic health records. The convergence of medicine and digital technologies is creating an information ecosystem that will facilitate more efficient preventative, diagnostic and therapeutic solutions where citizens have access to their genetic and health data. High-capacity broadband networks that transmit large volumes of data will be important for concepts like personalized medicine and participatory health to become feasible.
Health Futures: Participatory Medicine and Crowdsourced Research StudiesMelanie Swan
There are numerous participatory health initiatives underway ranging from light-touch to heavy engagement including social media, mobile health applications, personal health records, consumer genomics, health social networks, and crowdsourced health studies. Crowdsourced health studies are emerging as an important new investigatory tool in a multi-tier research ecosystem that includes quantified self-experimentation, participant-organized studies, and traditional researcher-led clinical trials. Accessing crowdsourced cohorts for health studies is a significant emerging opportunity that could have a positive impact on public health research, particularly as outcomes are shifting to the personalized, preventive medicine of the future.
Presentation given at Health Informatics and Knowledge Management conference
(http://publichealth.curtin.edu.au/HIKM/), as part of Australasian Computer Science Week 2012.
http://www.cs.rmit.edu.au/acsw2012/
The document discusses the transition from personalized medicine to personal health. It notes the current challenges in medicine including the need for earlier diagnosis, more personalized therapies, and improved disease classification. Personalized medicine uses an individual's genetic and molecular profile to guide risk assessment and treatment. However, personal health empowers patients by providing them access to their own health data through technologies like sensors, apps, and personal health records. This allows patients to better monitor and manage their health. Realizing personal health will require overcoming challenges regarding privacy, security, and ensuring equitable access to technologies and data interpretation.
Presentation by Prof. Fernando Martin-Sanchez at the "Carlton Connect" Interdisciplinary conference in Melbourne, 2012.
http://www.carltonconnect.com.au/Conference/Conference.html
How to address privacy, ethical and regulatory issues: Examples in cognitive ...SharpBrains
How to address privacy, ethical and regulatory issues: Examples in cognitive enhancement, depression and ADHD
Dr. Karen Rommelfanger, Director of the Neuroethics Program at Emory University
Dr. Anna Wexler, Assistant Professor at the Perelman School of Medicine at UPenn
Jacqueline Studer, Senior VP and General Counsel of Akili Interactive Labs
Chaired by: Keith Epstein, Healthcare Practice Leader at Blue Heron
Slidedeck supporting presentation and discussion during the 2019 SharpBrains Virtual Summit: The Future of Brain Health (March 7-9th). Learn more at:
https://sharpbrains.com/summit-2019/
1. The document discusses using heterogeneous biological data to advance scientific discovery by overcoming complexity.
2. It describes how new technologies now allow generation of massive human "omics" data and emerging network modeling approaches for diseases.
3. Integrating this data through cloud computing infrastructure can enable a generative open approach to solving biomedical problems.
Stephen Friend Cytoscape Retreat 2011-05-20Sage Base
Use of Bionetworks to Build Maps of Disease
Stephen Friend proposes using "data intensive science", also known as the "fourth scientific paradigm", to build better maps of human disease. This approach utilizes massive amounts of biological and clinical data from populations, along with computational modeling, to construct networks that model disease. Integrating diverse data types can provide insights into disease mechanisms and causal relationships that enable more accurate predictions. Bionetworks approaches have the potential to advance the understanding and treatment of complex diseases.
Talk entitled "from the Virtual Human to a Digital Me" presented at the Virtual Physiological Human 2012 Conference held at IET Savoy, Savoy Place, London, 18-20 September 2012.
1) The document discusses the Future Health department at KU Leuven which conducts research in health decision support for professionals, patients, and policymakers.
2) The department takes an interdisciplinary approach and focuses on using data mining, IT, and software design to extract appropriate information from clinical, biomedical, and other health data sources to provide decision support.
3) The goal is to enable better, more cost effective healthcare by providing personalized decision support that is evidence-based, user-centered, and looks ahead to future needs.
The document discusses personalised medicine and some of the challenges in delivering on its promises. It provides an overview of initiatives like the Human Genome Project, Virtual Physiological Human, and case studies using VPH simulations. It discusses challenges ahead like integrating data across different scales and developing clinical decision support tools. The document argues that while progress has been made, fully realizing personalized medicine will require overcoming remaining challenges.
The document discusses a conference on the role of telehealth in managing rural neuroemergencies. It provides context on the healthcare environment including reforms, technology advances, and challenges in access to care. Telehealth and health information technology are presented as part of the solution to close gaps in rural healthcare access through clinical consultations, education, and health information exchange. Examples of telehealth applications described include telestroke assessments, maternal-fetal medicine, teleradiology, and remote patient monitoring.
The document discusses a conference on the role of telehealth in managing rural neuroemergencies. It provides context on the healthcare environment including reforms, technology advances, and challenges in access to care. Telehealth and health information technology are presented as part of the solution to close gaps in rural healthcare access through clinical consultations, education, and health information exchange. Examples of telehealth applications described include telestroke assessments, maternal-fetal medicine, teleradiology, and remote patient monitoring.
This document discusses healthcare analytics and how big data can be used in healthcare. It notes that healthcare analytics focuses on either precision of diagnosis and treatment using large amounts of data on individual patients, or improving quality, cost and operations using some patient data across many individuals. The document provides examples of how analytics could help identify frequent emergency room visitors to intervene, optimize end of life care, and reduce unnecessary "defensive care". Both areas are data problems that can be addressed with large individual patient datasets or smaller datasets across many patients.
Cemal H. Guvercin MedicReS 5th World Congress MedicReS
Ethical Issues in Artifical Intelligence Applied to Medicine Presentation to MedicReS 5th World Congress on October 19,25,2015 in New York by Cemal H. Guvercin, MD, PhD
eHealth Governance in a Local Organisation. The Experience from Pompidou Hospital. Degoulet P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Theera-Ampornpunt N. The intersection of ICT and health informatics research. Presented at: Faculty of ICT, Mahidol University; 2012 Feb 24; Bangkok, Thailand.
Research Frontier: Cognitive Performance GenomicsMelanie Swan
Research Frontier: Cognitive Performance Genomics
New category in personal genomics research
Working with the brain: virtually all cognitive performance and mental health issues are a question of awareness of state or behavior
This document discusses how broadband technologies can enable personalized and participatory medicine. It describes how broadband can help improve youth mental health services and aged care through remote monitoring, telehealth, and electronic health records. The convergence of medicine and digital technologies is creating an information ecosystem that will facilitate more efficient preventative, diagnostic and therapeutic solutions where citizens have access to their genetic and health data. High-capacity broadband networks that transmit large volumes of data will be important for concepts like personalized medicine and participatory health to become feasible.
Health Futures: Participatory Medicine and Crowdsourced Research StudiesMelanie Swan
There are numerous participatory health initiatives underway ranging from light-touch to heavy engagement including social media, mobile health applications, personal health records, consumer genomics, health social networks, and crowdsourced health studies. Crowdsourced health studies are emerging as an important new investigatory tool in a multi-tier research ecosystem that includes quantified self-experimentation, participant-organized studies, and traditional researcher-led clinical trials. Accessing crowdsourced cohorts for health studies is a significant emerging opportunity that could have a positive impact on public health research, particularly as outcomes are shifting to the personalized, preventive medicine of the future.
Presentation given at Health Informatics and Knowledge Management conference
(http://publichealth.curtin.edu.au/HIKM/), as part of Australasian Computer Science Week 2012.
http://www.cs.rmit.edu.au/acsw2012/
The document discusses the transition from personalized medicine to personal health. It notes the current challenges in medicine including the need for earlier diagnosis, more personalized therapies, and improved disease classification. Personalized medicine uses an individual's genetic and molecular profile to guide risk assessment and treatment. However, personal health empowers patients by providing them access to their own health data through technologies like sensors, apps, and personal health records. This allows patients to better monitor and manage their health. Realizing personal health will require overcoming challenges regarding privacy, security, and ensuring equitable access to technologies and data interpretation.
Presentation by Prof. Fernando Martin-Sanchez at the "Carlton Connect" Interdisciplinary conference in Melbourne, 2012.
http://www.carltonconnect.com.au/Conference/Conference.html
How to address privacy, ethical and regulatory issues: Examples in cognitive ...SharpBrains
How to address privacy, ethical and regulatory issues: Examples in cognitive enhancement, depression and ADHD
Dr. Karen Rommelfanger, Director of the Neuroethics Program at Emory University
Dr. Anna Wexler, Assistant Professor at the Perelman School of Medicine at UPenn
Jacqueline Studer, Senior VP and General Counsel of Akili Interactive Labs
Chaired by: Keith Epstein, Healthcare Practice Leader at Blue Heron
Slidedeck supporting presentation and discussion during the 2019 SharpBrains Virtual Summit: The Future of Brain Health (March 7-9th). Learn more at:
https://sharpbrains.com/summit-2019/
1. The document discusses using heterogeneous biological data to advance scientific discovery by overcoming complexity.
2. It describes how new technologies now allow generation of massive human "omics" data and emerging network modeling approaches for diseases.
3. Integrating this data through cloud computing infrastructure can enable a generative open approach to solving biomedical problems.
Stephen Friend Cytoscape Retreat 2011-05-20Sage Base
Use of Bionetworks to Build Maps of Disease
Stephen Friend proposes using "data intensive science", also known as the "fourth scientific paradigm", to build better maps of human disease. This approach utilizes massive amounts of biological and clinical data from populations, along with computational modeling, to construct networks that model disease. Integrating diverse data types can provide insights into disease mechanisms and causal relationships that enable more accurate predictions. Bionetworks approaches have the potential to advance the understanding and treatment of complex diseases.
Talk entitled "from the Virtual Human to a Digital Me" presented at the Virtual Physiological Human 2012 Conference held at IET Savoy, Savoy Place, London, 18-20 September 2012.
1) The document discusses the Future Health department at KU Leuven which conducts research in health decision support for professionals, patients, and policymakers.
2) The department takes an interdisciplinary approach and focuses on using data mining, IT, and software design to extract appropriate information from clinical, biomedical, and other health data sources to provide decision support.
3) The goal is to enable better, more cost effective healthcare by providing personalized decision support that is evidence-based, user-centered, and looks ahead to future needs.
The document discusses personalised medicine and some of the challenges in delivering on its promises. It provides an overview of initiatives like the Human Genome Project, Virtual Physiological Human, and case studies using VPH simulations. It discusses challenges ahead like integrating data across different scales and developing clinical decision support tools. The document argues that while progress has been made, fully realizing personalized medicine will require overcoming remaining challenges.
The document discusses a conference on the role of telehealth in managing rural neuroemergencies. It provides context on the healthcare environment including reforms, technology advances, and challenges in access to care. Telehealth and health information technology are presented as part of the solution to close gaps in rural healthcare access through clinical consultations, education, and health information exchange. Examples of telehealth applications described include telestroke assessments, maternal-fetal medicine, teleradiology, and remote patient monitoring.
The document discusses a conference on the role of telehealth in managing rural neuroemergencies. It provides context on the healthcare environment including reforms, technology advances, and challenges in access to care. Telehealth and health information technology are presented as part of the solution to close gaps in rural healthcare access through clinical consultations, education, and health information exchange. Examples of telehealth applications described include telestroke assessments, maternal-fetal medicine, teleradiology, and remote patient monitoring.
This document discusses healthcare analytics and how big data can be used in healthcare. It notes that healthcare analytics focuses on either precision of diagnosis and treatment using large amounts of data on individual patients, or improving quality, cost and operations using some patient data across many individuals. The document provides examples of how analytics could help identify frequent emergency room visitors to intervene, optimize end of life care, and reduce unnecessary "defensive care". Both areas are data problems that can be addressed with large individual patient datasets or smaller datasets across many patients.
Cemal H. Guvercin MedicReS 5th World Congress MedicReS
Ethical Issues in Artifical Intelligence Applied to Medicine Presentation to MedicReS 5th World Congress on October 19,25,2015 in New York by Cemal H. Guvercin, MD, PhD
1. The Future of Allopathic Medicine
Michael M.E. Johns, MD
Executive Vice President for Health Affairs
CEO, Woodruff Health Sciences Center
Chairman of the Board, Emory Healthcare
Emory University
2. Workforce Projections
A Long History of Getting it Wrong!
Looming Shortages? Surpluses?
• Then
– GEMENAC (1977) and progeny through 1980s
– Cooper 1994
– Weiner 1994
– COGME 1995
• Now
– U.S.Bureau/Health Professions (shortage areas)
– Wennberg 2006 (OK as is - just rationalize effort)
– AAMC 2006 (increase med students by 30%)
• Always
– Shortages in areas of greatest need (rural, inner city).
3. Workforce Projections
A Long History of Getting it Wrong!
What do current projections of shortages mean for
future professionals . . . ?
4. Demand Prices
P - price
Q - quantity of good
S - supply
D - demand
5. Factors Affecting Your Future
Both catalyzing and limiting factors:
1. Lack of universal coverage
2. Costs
3. Demographics (longevity, baby boomers, etc.)
4. Dysfunctional health care delivery and
payment systems.
5. Demand for health care services.
6. Regulatory burden
7. Administrative waste ($40 billion/year on paper
records alone).
6. More factors
6. Quality, safety and service deficits
7. No standard, universal transaction
platform.
8. Lack of universal, secure, personal
medical records.
9. Ethics/loss of professionalism/focus on
profitability vs meeting important
health care needs.
8. 3. Acceleration of technology and knowledge
NanoTechnology: bringing together molecular biology,
biomedical engineering, imaging, robotics for diagnosis and
treatment.
10. New Patient Health
Home?
• WA Seattle Metro Locations
“There’s really no secret
behind MinuteClinic’s better
approach to diagnosing and
treating common illnesses:
・ Quick (about 15-minute
visits and no appointment
needed).
・ Affordable (treatments
between $28 and $110, and
reimbursed by most
insurance plans).
・ Convenient (open seven
days a week, located near
pharmacies).”
11. “Prescription for a Busy Life”
Common Illnesses/Pricing
Allergies (ages 6+)$59
Bladder Infections (Females, ages 12-64)$69
Bronchitis (ages 10-64)$59
Ear Infections$59
Pink Eye and Styes$59
Sinus Infections (ages 5+)$59
Strep Throat$69
Swimmer’s Ear$59
Flu Diagnosis (ages 10-64)$93
Mononucleosis$69
Pregnancy Testing$49
12. Newer factors: 5. Convergence
Convergence creates new tools enabling
new alignment of how people will work
together.
Example: iPod
•Required acquiring and aligning multiple
resources
–Technologies
–IP
–People
–Companies
13. Innovative Convergence around iPod
Tony Fadell,
Apple Computer's Senior VP, iPod Division
CONCEPT
File Transfer Chip Design
Compatibility Mobile HDD
CONCEPT
SOFTWARE
Functionality Digital Converter
cliché software
HARDWARE
Planar Lithium
Music Production
Battery
eMagic Storage
Flash
Memory Chip
CONTENT
Firewire
SHRINK Music
(1394)
Books
14. Emergence
Convergence
leads to . . .
Emergence
of new concepts for biomedicine
15. Predictive Health
“Predictive Health anticipates the course of
an individual’s health status, based on
leading edge science and technology, and
prescribes interventions that proactively
optimize wellness”
“This revolutionary approach will move from a
reactive disease focused system to a pro
active health focused system; disease
becomes a medical failure”
16. The Health/Disease Continuum
Normal Normal Pre Early Late
Low risk High risk disease disease disease
D
H Predictive Health I
E
S
A
E
L
A
T Contemporary Medicine
S
H
E
17. Determinants of
Health
NIH Roadmap Initiative: NIH Roadmap Initiative:
New Pathways to Discovery Research Teams Of The Future
Environment
Genomics/ Population
Metabolomics/ Biology
Proteomics Genetics Behavior
Molecular Imaging Systems Biology
Generic Pathways
Bioinformatics
Ethics
Technologies Disciplines
Immunology
and
Nanomedicine
Inflammation Public Policy
Development
Oxidative
and
Quantitative Stress Finance and
Senescence
Medicine Economics
Novel Other Generic Regeneration
Education
Therapeutics Pathways and Repair
Building Block, Biological Specific Diseases
Pathways, and Networks Cardiovascular High Risk Research
Cancer
Diseases
Molecular Libraries and Interdisciplinary Research
Imaging Chronic Lung Diabetes Public-Private
Other Diseases
Structural Biology Diseases Partnerships
Neurological
Bioinformatics and
Diseases
Computational Biology
Nanomedicine NIH Roadmap Initiative: Re-engineering The Clinical Research Enterprise
18. The Question for the Future
The question is not:
“What will medicine look like in 20 years?”
The question is:
“What can medicine be in 20 years?”
And:
“What can we aspire to be as leaders in
fulfilling that vision?”
19. The Future of Allopathic Medicine
It’s your future.
Learn -- to be a leader.
Editor's Notes
I was sent to a Jesuit school when I was very young, and the first thing they teach you is to challenge the premise. I’m sure that Jordy, who has known me a long time, knows that I learned that lesson well!! So here goes: Is the current prediction of a looming shortage accurate? I have to say that we’ve been down this road before . . . . The physician shortage would be different if we stooped taking a physician centric point of view and recognized the expanded role that NPs and other health professionals could assume. This would take a work load away from the generalists and mollify any potential shortages that are pending. The bottom line is that we have always had shortages in the areas of greatest need . . .
But what if the current projections are right?
Well, I guess that means that all of you are in pretty good shape. Remember the old supply and demand curve? Well being scarce will certainly improve your relative mobility and the premium for your work! But I hope that this is not the aspect of this possible future that most concerns any of you, first, because you can’t count on it, and second, of course, because we are talking about a calling here, where it is the quality and humanity of our work that is most rewarding . . . And in case any of you thinks that the road ahead is without road bumps, think again!
Here are some major factors that both catalyze and limit Lack of universal coverage Costs Demographics (Longevity, Baby Boomers, etc.) Dysfunctional Health Care Delivery and Payment Systems. Insatiable Demand for Health Care Services. Enormous Regulatory Burden and Administrative Waste ($40 Billion/year on paper records alone).
Widespread Quality, Safety and Service Deficits. Lack of a Standard, Universal Transaction Platform. Lack of Universal, Secure, Personal Medical Records. Ethics/Loss of Professionalism/Focus on Profitability vs. Meeting Important Health Care Needs. Widespread Quality, Safety and Service Deficits. Lack of a Standard, Universal Transaction Platform. Lack of Universal, Secure, Personal Medical Records. Ethics/Loss of Professionalism/Focus on Profitability vs. Meeting Important Health Care Needs
These ongoing issues are now supplemented by newer factors: First, Societal expectations. Patients and families, and payors too, are demanding more of us and we are demanding more of ourselves, especially in terms of quality, cost and value of our services. Agencies like the AHRQ are facilitating new resources for understanding and measuring quality. Globalization: The world is flat. Health opportunities, yes, but also risks: SARS, AIDS, Pandemic Flu, etc.
Another factor is the acceleration of technology and discovery, and the continuing growth in our knowledge base. With the amount of new knowledge being generated and published, a professional would need to read 19 journals a night to keep up. Obviously this can’t be done. What we need are new technologies that supplement and compensate for our individual or collective limitations in assimilating knowledge. Technology: One example, which we have here at Emory is nanotechnology. Our joint department of biomedical engineering that we have developed with GA Tech is a model of scientific integration of many disciplines and technologies. This particular technology is point us towards major breakthroughs in a wide variety of diagnostic and therapeutic capabilities . . .
Need to think differently about medical homes. Need to think in terms of health homes . . . EBM and care teams . . . And for patients, we need to think about whether their health home is in fact the home! We can see movement in that direction already. One example is . . .
Easy-access clinics that are moving into the neighborhood in new ways. So here we are in Seattle. Feeling a little out of sorts? Feel an ear infection coming on? Don’t want to go wait in an ED? How about seeing the health provider at the “Minute Clinic” in your local pharmacy? Minute Clinic may be the new model of the patient’s health home . . . . And they have the pricing to go with it . . . [next slide]
I’m told that lots of folks come in and pay cash! Now what if we take this a couple of steps further and imagine the home for care actually transitioning to the home. Why couldn’t we have computer sytems that access sophisticated interactive diagnostic sites where evidence-based algorithms can be accessed by the patient sitting at home, wearing a monitor on his or her index finger? Voice recognition and voice over internet capabilities enable a carefully structured, automated interview, with the patient’s history already in the database, along with all meds, tests and so forth. You could imagine a whole host of symptoms and illnesses that could be managed remotely in this way, thereby possibly eliminating the need for many human providers at that level of patient service. . . .
New health homes, new technologies, societal and global factors --, all of these factors are converging to shape the future of allopathic medicine. But this doesn’t mean that we are just meant to sit around and wait for these things to happen or just to accommodate to them. The big things that are happening are happening more often by design than by accident. The really smart people and agencies and corporations know that great progress means pulling together the resources you need, sometimes in unexpected ways and with unexpected partners. Let’s take a well known recent innovation as an example . . . .
[Talk through this slide . . . ] . . . . Well, exactly this sort of convergence is what is beginning to occur in health care . . . .
And as we’ve seen with the iPod, well conceived and well executed convergence can lead to the transformative emergence -- emergence of new possibilities for medicine and health.
And perhaps the most exciting thing that I see emerging from so much that I see developing in our science and in new models of care, is the capability to achieve the promise of 21st century medicine in the transition to predictive health. Predictive health is healthcare that is proactive and preemptive. It is care that understands not just disease, but health and is focused on optimizing and maintaining health for a lifetime. It is about what I call maintaining a Square wave life curve . . .
Predictive health reverses the traditional health disease continuum.
Here is how convergence is working to shape this future. There are the determinants of health . . . [click] There are the technologies converging as well as [click] The many disciplines The public sector is invested through intiatives like [click] the NIH Roadmap with both pathways to discovery and [click] the fostering of research teams and now the [click] clinical research initiative And then all of this is also converging with new disciplines that are emerging and vital new and expanding private/public partnerships. There is extraordinary work going on in genomics and proteomics, nanotechnologies, molecular imaging, biomedical engineering, transplant biology, vascular biology, robotics, systems and computational biology and in many other areas that promise to transform medicine in this century. We can already see the outlines of new fields of medicine, like regenerative medicine, where tissues and organs would be regenerated from stem cells and through artificial replication. This means that the preparation of health professionals must begin to incorporate a broader array of capabilities: Preparation in computation, physics, mathematics, Professionals who can work easily and creatively and with flexibility in various types of colleagues and in non-traditional settings. Need health professionals with a global perspective. Technological proficiency, including remote and interactive. Ability to work across populations, in diverse social, political, and economic environments.
And all of this comes down to being part of the team that is leading this developing new era of health and healing. This is about Leadership. SO the question is not what will medicine look like in 20 years? The question is what can medicine be in 20 years and what can each of us and all of us together aspire to be as leaders in fulfilling that vision? The challenges will continue to mount as we become even more ambitious for our selves and for our health system and for our patients. Everyone in this room needs to be thinking about not just becoming a true professional, but about becoming a true leader . . .
It’s your future. Take charge of it and lead. Thank you.